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Compartment Syndrome

UW Health's Sports Medicine doctors treat a wide range of common athletic injuries.

 

Compartment syndrome can occur in many areas of the body, but most frequently occurs in the calf. Your lower leg is divided into four compartments - anterior, lateral, posterior and deep posterior. Compartment syndrome is caused by increased pressure within one, two or all the compartments of the lower leg. The increased pressure within the lower leg compresses against very important structures including nerves, arteries and veins.
 
This contributes to a lack of blood flow to the area, which results in a lack of oxygen (ischemia) for the muscles. The diagnosis of compartment syndrome is primarily based on clinical based symptoms but your physician may order a diagnostic test to measure the “pressures” of the compartments of the lower extremity.
 
Two Types of Compartment Syndrome 
  • Acute Compartment Syndrome (ACS): ACS is typically caused by blunt trauma that causes immediate swelling and pain to the lower leg. This causes the pressures in your lower leg to increase rapidly causing pressure on your nerves, arteries and veins. This is a medical emergency.
  • Chronic Compartment Syndrome (CCS): CCS is usually associated with pain during exercise. It is also caused by rapidly increasing pressures in your lower leg but occurs during activity. Elimination of symptoms results when stopping the activity. 
Signs and Symptoms of Acute Compartment Syndrome 
  • Acute trauma to the lower leg
  • Immediate pain and cramping
  • Immediate swelling and severe tightness
  • Skin changes - may look "black and blue"
Signs and Symptoms of Chronic Compartment Syndrome 
  • Cramping, burning, pain, tightness or aching, numbness or tingling to your lower leg associated with exercise
  • Your symptoms improve when you stop exercising
  • Severe tightness of the lower leg with palpation or touch
Treatment
 
Initial treatment of acute compartment syndrome is referral to the emergency room for further evaluation and possible fasciotomy (release of tissue to reduce pressure).
 
Treatment for chronic compartment syndrome is based on symptoms. Physical therapy can help with the focus on calf stretching, soft tissue mobilization, massage and activity modification. Medical professionals may also assist in identifying appropriate shoe wear. The mainstay of treatment is fasciotomy or fasciectomy (release or removal). This is a surgical technique used to release the compartments of the lower leg and create more space for the tissues to expand.
 
More information: UW Health Compartment Syndrome Clinic
 
Summary
 
If you are feeling that you may have the symptoms of compartment syndrome, check with your physician, local licensed athletic trainer or physical therapist to help you get the appropriate diagnosis and medical care.
 
References
 
1. Turnipseed, William MD, Detmer Don MD, Girdley Forrest PA. Chronic Compartment Syndrome. An Unususal Cause for Claudication. Ann. Surg. October 1989. 557- 562.
 
2. Blackman, Paul. A reveiw of chronic exertional compartment syndrome in the lower leg. Medicine and Science in Sports and Exercise. Vol. 32, No. 3, Suppl., pp.S4- S10, 2000.
 
3. Esmail, Adil MD, Flynn, John MD, Ganley, Thomas MD, Pill, Stephan MS, PT. Acute Exercise-Induced Compartment Syndrom e in the Anterior Leg. The American Journal of Sports Medicine. Vol. 29, No. 4. 509- 512.2001.
 
4. Slimmon, Drew PhD, Bennell, PhD, Brukner Peter, MBBS, FACSP, Crossley Kay, BAppSci(physio), Bell, Simon, MBBS, FRACS. Long-Term Outcome of Fasciotomy with Partial Fasciectomy for Chronic Exertional Compartment Syndrome of the Lower Leg. The American Journal of Sports Medicine. Vol. 30, No. 4. 581-588. 2002.
 
5. Machold, Wolfgang MD, Muellner, Thomas MD, Kwasny, Oskar MD. Is the Return to High-Level Athletics Possible After Fasciotomy for a Compartment Syndrome of the Thigh? The American Journal of Sports Medicine. Vol. 28, No. 3. 407-410. 2000.